Renal failure, respiratory distress, and an atypical purpuric rash in a full-term infant with omphalocele and hypospadias: Questions

Excerpt

A full-term male infant was transferred from a referring hospital at 15 days of life with history of omphalocele and hypospadias. Neither amniocentesis nor microarray revealed an underlying genetic etiology for these anomalies. Family history was also unremarkable and non-contributory to the following presentation. Aside from briefly requiring non-invasive respiratory support after delivery, the majority of the neonate’s initial hospital course was uneventful. However, in the 48 h prior to transfer, the child developed intermittent tachypnea, decreased urine output, hypertension, and bilateral non-blanching purpuric rashes on the dorsal portion of his lower extremities (Fig. 1a, b). At that time, labs were notable for hyponatremia, and an echocardiogram revealed an echogenic focus on the mitral valve. He was ultimately transferred for ongoing assessment and subspecialty evaluation.

…